Healthcare Provider Details

I. General information

NPI: 1790432466
Provider Name (Legal Business Name): TONI KEGLOVITZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4187 S QUARTERLINE RD
MUSKEGON MI
49444-4236
US

IV. Provider business mailing address

4187 S QUARTERLINE RD
MUSKEGON MI
49444-4236
US

V. Phone/Fax

Practice location:
  • Phone: 231-750-7432
  • Fax:
Mailing address:
  • Phone: 231-750-7432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501002828
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: